Thrombosis in Rheumatological Diseases

Bashal, Fozya

doi:10.1007/978-981-15-8323-0_12

Cited by 2 publications

(2 citation statements)

References 45 publications

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“…Additionally, dosing appeared standardized, and it is unclear if any adjustments were made based on patient characteristics, such as obesity. These factors are significant risk factors for VTE [19–24] and may explain why our reported incidence was much lower.…”

Section: Discussionmentioning

confidence: 67%

Real-world comparative effectiveness of dalteparin and enoxaparin for venous thromboembolism prophylaxis

Di Mauro,

Austin,

Zande

et al. 2024

Blood Coagulation &Amp; Fibrinolysis

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Venous thromboembolism (VTE) is a preventable cause of significant morbidity and mortality in hospitalized patients world-wide. In Australia, the low-molecular weight heparins (LMWHs) enoxaparin or dalteparin are usually used as first-line prophylaxis for VTE, though there is uncertainty whether dalteparin has the same effectiveness as enoxaparin in real-world settings. This is relevant because dalteparin is less renally cleared and may be more cost effective than enoxaparin. The aim of this study was to explore VTE event incidence in a general cohort of hospitalized adult inpatients who were prescribed enoxaparin or dalteparin for VTE prophylaxis. A retrospective observational study was conducted at a quaternary hospital in Brisbane, Australia, of patients who had experienced a hospital-acquired VTE from 1 September 2021 to 1 March 2023. Patients were identified from routinely collected data following an in-hospital VTE event, and further data was retrieved retrospectively from the integrated electronic Medical Record (ieMR). Incidence and type of VTE events, LMWH-prescribing patterns, and risk factors were assessed. The incidence of VTE events were similar across the dalteparin and enoxaparin cohorts (42.1 events/10 000 patients vs. 34.4 events/10 000 patients, respectively), although patients prescribed enoxaparin had a higher number of risk factors, particularly obesity and active cancer. Our research indicates comparable incidence of VTE in patients prescribed dalteparin compared with enoxaparin in an Australian hospital general cohort of adult inpatients. Dalteparin may be as effective as enoxaparin for VTE prophylaxis in a real-world cohort of patients, and as such dalteparin may be considered a suitable alternative to enoxaparin for VTE prophylaxis. Further research including large randomized controlled trials are required to confirm these results.

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Section: Discussionmentioning

confidence: 67%

Real-world comparative effectiveness of dalteparin and enoxaparin for venous thromboembolism prophylaxis

Di Mauro,

Austin,

Zande

et al. 2024

Blood Coagulation &Amp; Fibrinolysis

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“…It is considered a benign self-limited condition, but in our case, EFN presented in a patient subsequently diagnosed with UCTD, which, to our current knowledge, has not been previously described, warranting clinical awareness of this potential association in this population. Rheumatologic conditions such as systemic lupus erythematosus (SLE) and UCTD have been linked to an increased risk of thrombosis, to which factors such as inflammation, endothelial dysfunction, and antiphospholipid antibodies, especially lupus anticoagulant, play a significant role [ 9 – 17 ]. The authors hypothesize that this prothrombotic status might be a predisposing cause leading to EFN in this patient, although further research is needed.…”

Section: Discussionmentioning

confidence: 99%

Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

Barreto

Oliveira

Barreira

et al. 2023

BMC Cardiovasc Disord

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Background Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER). Case presentation A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms. The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities. A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest. The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud’s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made. Conclusions This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.

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Thrombosis in Rheumatological Diseases

Cited by 2 publications

References 45 publications

Real-world comparative effectiveness of dalteparin and enoxaparin for venous thromboembolism prophylaxis

Real-world comparative effectiveness of dalteparin and enoxaparin for venous thromboembolism prophylaxis

Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

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